Test Bánk For Leáding and Managing in

Nursing, 8th Edition

MULTIPLE RESPONSE

1. A new graduate nurse wonders about the directions that her preceptor has given her regarding
management of incontinent, confused patients. The new nurse brings the preceptor evidence-
based information she located regarding incontinence interventions for confused patients
and asks to talk about the guidance that given after the preceptor reviews the information in
the article. What is the new nurse demonstrating in this situation? (Select all that apply.)
a. Assertiveness
b. Followership

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 c. Management
d. Insubordination
ANS: A, B
This is an example of followership in which a staff nurse is demonstrating assertive behavior
and presenting evidence that may influence the decision making of her nurse leader and
manager.

TOP: AONE competency: Knowledge of the Health Care Environment

Chapter 02: Quality and Safety

MULTIPLE CHOICE

1. In an effort to control costs and maximize revenues, the Rehabilitation Unit at Cross
Hospital reduced the number of its managers and increased the number of units for which
each manager was responsible. Within a year, the number of adverse events on the units
had doubled. How do the increase in adverse events relate to decreased managers? a. The
overload of staff nurse duties
b. Resistance to change by staff
c. A change in reporting system for everyone
d. Fewer clinical leaders to facilitate best practice
ANS: D
Eliminating barriers to the implementation of best practices is the role of managers and
leaders. When there are insufficient resources for leadership to encourage a culture in which
evidence-based practice is embraced, frontline nurses recognize this as a stumbling block for
delivering quality care.

TOP: AONE competency: Knowledge of the Health Care Environment

2. The Rehabilitation Unit at Pleasant Valley Hospital has a high number of falls.
What interventions might assist to reduce the number of falls on the unit? a.
Determining who is responsible for the falls
b. Strengthening unit policies to avoid inappropriate admissions
c. Encouraging involvement of nurses in education related to falls and safety
d. Ensuring that patients are appropriately restrained if they are at risk for falls
ANS: C
The IOM (2010) emphasizes the need for nurses to engage in lifelong learning and to use
evidence and best practices to inform practice and ensure safety.

TOP: AONE competency: Professionalism

3. How would the nurse executive begin to increase safety in patient care areas of the Valley
Hospital?
a. Asking the community what the safety issues are

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 b. Consulting with a management expert about staffing schedules
c. Ensuring that the senior nursing officer attends the board meetings
d. Instituting improved practices to reduce needlestick injuries
ANS: C
The IOM report (2004) highlighted the importance of the attendance of the senior nurse
executive at board meetings to be a key spokesperson on safety and quality issues.

TOP: AONE competency: Knowledge of the Health Care Environment

4. During review of back injuries, it is determined that a large number of injuries are occurring
in spite of mechanical lifts being used. Furthermore, it is determined that some lifts are
outdated. In addressing this concern, the unit manager:
a. meets individually with nurses who are observed to be using the lifts incorrectly to
review the correct procedure.
b. after consultation with the staff about the review, orders new lifts to replace older ones
that are malfunctioning.
c. blames the system for inadequate funding for resources.
d. reviews the system of reporting incidents to ensure that appropriate reporting is
occurring.
ANS: A
The involvement of staff nurses in safety on the unit is imperative in improvement of quality
and the provision of patient care. This is a relationship engagement by the manager to
engage the nurses and building these relationships improves quality.
TOP: AONE competency: Communication and Relationship-Building

5. What did the IOM Health Professions Education report highlight as a concern for patient
safety?
a. A normal risk in professional practice
b. A result of disciplinary silos
c. A reflection of frontline staff
d. Related to systems errors
ANS: B
The IOM Health Professions Education report (2004) highlighted the education of health
disciplines in silos as a major concern in patient safety and endorsed five recommendations.
One to be increased and improved communication between the health disciplines.

TOP: AONE competency: Knowledge of the Health Care Environment

6. A nurse manager is implementing strategies to support the steps in the AHRQ Team
Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS 2.0)
What does the manager include in the implementation?
a. Train staff in teamwork skills to work with patients who have difficulty communicating
in English.
b. Rules and decisions are made through centralized processes.
c. You monitor the performance of each staff member closely.
d. Preference is given to increasing staff numbers rather than staff credentials.

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 ANS: A
One of the most widely used evidence-based teamwork systems to improve communication
and teamwork skills to improve patient safety within organizations is the AHRQ Team
Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS 2.0).
Teamwork is one of the key safety initiatives that can transform a healthcare culture.

TOP: AONE competency: Knowledge of the Health Care Environment

7. After consulting with practice environments about quality and safety concerns in health care,
a dean in a health care program implements what to improve quality and safety in health
care? a. A nursing program that emphasizes the development of a strong disciplinary
identity.
b. Programming that stresses discipline-based research.
c. Partnerships with health care to develop software for the reporting of adverse
events.
d. An interdisciplinary program for nurses, pharmacists, and medical practitioners that
emphasizes collaborative learning teams.
ANS: D
Health Professions Education identified that education related to health disciplines in
silos leads to compromised communication and inability to function as an integrated
whole for patient-centered care.

TOP: AONE competency: Knowledge of the Health Care Environment

8. What would be the primary emphasis in designing and implementing a quality, safe
healthcare environment?
a. Evidence-based practice
b. Informatics
c. Staffing
d. The patient
ANS: D
Focusing on the patient moves care from concern about who controls care to a focus on what
care is provided to and with patients, which was an aim identified in the IOM report
Crossing the Quality Chasm.

TOP: AONE competency: Knowledge of the Health Care Environment

9. The nurse is educating older adult patients on staying safe in the healthcare system. What
information does the nurse include in the teaching?
a. The need to understand and record all medications being taken.
b. Bringing their own linens and other personal items to the hospital.
c. Washing hands frequently while in a healthcare environment and using a hand sanitizer.
d. Following closely the directions and orders of healthcare providers.
ANS: A
Patients should be encourage to keep a list of medications they are taking including herbal
medications and share those with their healthcare provider.

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 TOP: AONE competency: Knowledge of the Health Care Environment

10. As a nurse manager on the West Surgery Unit, you are interested in increasing patient safety
and reducing morbidity and mortality on your unit. What recommendations would be
consistent with the IOM The Future of Nursing report?
a. Careful screening of nursing staff for substance use and abuse
b. Increased RN staffing on the unit
c. Salary and benefits that reflect nursing accountabilities
d. Increase in the percentage of baccalaureate-prepared nurses to 80%
ANS: D
The Future of Nursing advocates for having 80% of the nursing population at a
baccalaureate-prepared level. This recommendation reflects research that suggests that
improved mortality and morbidity rates occur with a better educated work force.

TOP: AONE competency: Knowledge of the Health Care Environment

11. On the West Surgery unit, you want to institute a new system for checking armbands that
evidence suggests may increase safety in medication administration. The system
involves technology. What strategy may assist with rapid adoption of the technology and
system? a. Employ a centralized decision-making approach.
b. Use simulators for initial practice to build confidence.
c. Bring in a nurse consultant who is familiar with the technology.
d. Use early adopters among the staff as leaders and role models in implementation.
ANS: D
The Institute for Healthcare Improvement (IHI) is dedicated to rapid improvement in patient
care through a variety of mechanisms such as rapid cycle change. Rapid cycle change
diffuses innovation and changes quickly through early adopters who share information and
energy over time and act as role models for others.

TOP: AONE competency: Knowledge of the Health Care Environment

12. To achieve Nurse-Sensitive Care Standards developed by the NQF, you advocate for which
of the following in your health facility?
a. Evidence-based practice to reduce the prevalence of pressure sores
b. Implementation of informatics at the bedside
c. Staff-manager conferences to review reporting of adverse medical events
d. Patient councils to review food, recreation, and nurse-patient relations
ANS: A
The National Quality Forum (NQF) outlines nursing-centered intervention measures related
to prevalence of pressure sores, ventilator-associated pneumonias, volunteer turnover,
nursing care hours per day, and skill mix of staff.

TOP: AONE competency: Knowledge of the Health Care Environment

13. You notice that Sally, a student on your unit, is giving information to an anxious young teen
who seems very uncertain about preparation for an upper GI series. After Sally leaves the

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 room, you ask her what she thought her conversation with the patient. What is the
appropriate response for you to give Sally?
a. Encourage her to ask the patient if he has questions or concerns about the procedure.
b. Advise her to consider providing the patient with more information.
c. Suggest that she leave some brochures on the procedure with the patient.
d. Suggest that she also provide teaching to the adolescent‘s parents.
ANS: A
The nurse can encourage patients to take a larger role in care by asking questions and
expressing concerns.

TOP: AONE competency: Communication and Relationship-Building

14. The NQF provides a model for advancement of healthcare quality that could be used in
healthcare organizations. What does the use of this model by the Centers for Medicare
and Medicaid Services specificity link with adverse patient events for healthcare
facilities? a. Staffing
b. Funding
c. Composition of executive councils
d. Composition of consumer-based councils
ANS: B
The Centers for Medicare and Medicaid Services (CMS) have adopted a policy based on the
NQF‘s ―Never Events.‖ The CMS will no longer pay for patient conditions or events that
result from poor practice while patients are under the care of a health professional.

TOP: AONE competency: Knowledge of the Health Care Environment

15. Pleasant Valley Hospital has amended its safety practices and policies. What has the
hospital elected to emphasize accordance with changes by The Joint Commission (TJC)?
a. Safety goals specific to Pleasant Valley
b. Decision-making processes
c. Sufficient staffing for safe care
d. Increased numbers of baccalaureate-prepared RNs
ANS: A
When TJC, a not-for-profit organization that accredits healthcare organizations, changed
its focus from processes to outcomes, it emphasized patient safety and issues setting-
specific annual patient safety goals.

TOP: AONE competency: Knowledge of the Health Care Environment

16. What would managers and staff review annually in order to ensure compliance with The Joint
Commission (TJC) to improve patient safety?
a.Appropriateness of charting terms and abbreviations
b.Nursing hours per patient
c.Acuity of patient admissions
d.Wait times for care

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 ANS: A
The Joint Commission issues setting-specific patient goals annually, as well as a list of
―do-not-use‖ terms, abbreviations, and symbols and sentinel events.

TOP: AONE competency: Knowledge of the Health Care Environment

17. How would a nurse manager and the staff prepare for redesignation as a Magnet ®Hospital?
a. Commit staff resources over a 6-month period to updating procedure manuals.
b. Educate staff through meetings and training sessions regarding appropriate answers
to questions.
c. Prepare a manual that outlines orientation procedures and ensure that all safety issues
are addressed.
d. Ensure that there are empirical data to support review of patient outcomes, actions
taken, and results of actions.
ANS: D
Through the Magnet®model, organizations must demonstrate how they provide excellence in
five areas. Between designation and redesignation as a Magnet ®organization, greater
emphasis is placed on empirical quality results.

TOP: AONE competency: Knowledge of the Health Care Environment

18. Sarah is a second-year nursing student. The clinical instructor overhears Sarah telling a
patient that she ―always‖ checks patients‘ bracelets before giving medication and she is not
sure how the nurses on the unit ―get away with‖ not making more errors than they do. The
clinical instructor pulls Sarah aside and explores with her how her communication might
affect the patient and what it reflects about her beliefs related to the team. What competency
does this action outline?
a. QSEN
b. IHI
c. DNV/NIAHO
d. AHRQ
ANS: A
The Quality and Safety Education for Nurses (QSEN) project provides resources related to
competencies that prelicensure and graduate students need to develop to serve as safe
practitioners. These competencies include leading and managing, teamwork and
collaboration.

TOP: AONE competency: Knowledge of the Health Care Environment

19. What does the SBAR approach to patient safety encourage?

a. Consistency in assessment and practices
b. Continuing education
c. Multidisciplinary approaches
d. Patient feedback

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 ANS: A
The use of SBAR (Situation, Background, Assessment, and Recommendation) checklists are
designed to decrease omission of important information and practices.

TOP: AONE competency: Knowledge of the Health Care Environment

20. As a manager in a new nursing home, where might you consult for guidance and evidence
to support the development of safe patient practices? a. Hospitals
b. Business
c. Industry
d. Outpatient clinics
ANS: A
Practices that were once mostly studied in hospital settings are now scrutinized for
implementation in other settings, such as outpatient clinics, rural settings, and nursing
homes.

TOP: AONE competency: Knowledge of the Health Care Environment

21. What facilitate the development of decision-making skills related to safe patient care for a
nurse manager?
a. Regular reflection on decisions
b. A culture of perfectionism
c. Recognition of who should be held responsible for individual errors
d. A culture of trust between the staff and you
ANS: A
Reflection on how well decisions were enacted enables knowledge of the complexity of
situations and ramifications of the decisions made. Reflection enables elimination of
strategies and methods that are inappropriate in meeting needs and aids in narrowing choices
of best actions to take.

TOP: AONE competency: Leadership

22. Mary, an 85-year-old patient with cognitive impairment and gross instability, wanders
continuously. Lately, she has fallen twice, and the family demands that she be restrained. As
the unit manager, you have initiated a least restraint practice. What is an appropriate action
in this situation?
a. Setting up a nursing team meeting to review practices
b. Calling the family to inform them of the practice
c. Initiating a multidisciplinary and family meeting to focus on Mary‘s needs
d. Restraining Mary to satisfy the family‘s wishes
ANS: C
Crossing the Quality Chasm emphasizes the importance of rendering care with the client
(client-centered) rather than to the client. In this situation, the patient includes family in
transparent discussions about quality needs and takes a team approach that involves
healthcare professionals, the family, Mary‘s needs, and evidence associated with safe
practice.

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 TOP: AONE competency: Knowledge of the Health Care Environment

23. A client requires an appendectomy. The surgeon explains the procedure and asks the client
to sign the consent. The patient speaks very little English and looks worried. What is the
appropriate action by the nurse?
a. Suggest that an interpreter explain the procedure to the client and answer any questions.
b. Ask the client if he has any questions.
c. Draw a picture to show the incision.
d. Not intervene.
ANS: A
Encouraging patients to ask questions when there are doubts and concerns and ensuring
understanding before surgery is performed are ways in which nurses can support patients in
having greater influence in their own care. In this situation, asking an interpreter to help
enables access to information for the patient and active assessment of his understanding.

TOP: AONE competency: Knowledge of the Health Care Environment

24. As the manager on an acute care medical unit, you note that the incidence of medication
errors has increased since the implementation of staffing changes. What is an important
stratagem to reduce errors?
a. Revisit reporting standards for medication errors in your organization.
b. Ensure that medication errors are consistently reported.
c. Provide staff with additional education related to safe practice in medication
administration.
d. Involve RN staff in determining reasons for errors and practice solutions to increase the
safety of medication administration.
ANS: D
Keeping Patients Safe: Transforming the Work Environment of Nurses (2004) identified
many past practices that had a negative impact on nurses, and thus on patients, and
recommended the inclusion of nurses in direct care in decision making involving their
practice. Future of Nursing: Leading Change, Advancing Health (2010) also emphasizes the
role of nurses as leaders in changes that improve health.
TOP: AONE competency: Professionalism

MULTIPLE RESPONSE

1. What patients would be considered ―at risk‖ consumers during a healthcare visit? (Select all
that apply.)
a. Clyde requires an anticoagulant. He tells the nurse about his medications. He does
not include an herbal supplement.
b. George is very shy and withdrawn. He asks the nurse to leave him alone.
c. Sarah is a new parent who finds that nurses on the children‘s unit are very helpful.
She is eager to accept all suggestions, including those that she does not yet
understand.

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 d. Claude is booked for bowel surgery. His doctor explains about the colostomy.
Later, Claude tells his wife that he really doesn‘t know what the doctor meant by
colostomy.
ANS: A, C, D
Safer health care involves the patient as an active consumer who keeps and brings a list of
all medications, including natural remedies and questions if there are doubts, concerns, or
lack of understanding.

TOP: AONE competency: Knowledge of the Health Care Environment

Chapter 03: Ethical and Legal Issues in Nursing

MULTIPLE CHOICE

1. The manager in the coronary care unit believes an important ethical consideration in
performance evaluations is to include the employee‘s good qualities and give
positive direction for professional growth. What ethical principle does this
represent? a. Justice
b. Fidelity
c. Beneficence
d. Nonmaleficence
ANS: D
Nonmaleficence refers to ―doing no harm.‖ For a nurse manager following this principle,
performance evaluation should emphasize an employee‘s good qualities and give positive
direction for growth. Destroying the employee‘s self-esteem and self-worth would be
considered doing harm under this principle.

TOP: AONE competency: Professionalism

2. A staff nurse in the area that you manage has excelled in the delivery of patient education.
You are considering implementing a new job description that would broaden her
opportunity to teach patients and orient new staff members to the value of patient
education. What ethical principle is being reinforced? a. Justice
b. Fidelity
c. Paternalism
d. Respect for others
ANS: C
The principle of paternalism allows one person to make partial decisions for another and is
most frequently deemed to be a negative or undesirable principle. Paternalism, however,
may be used to assist persons to make decisions when they do not have sufficient data or
expertise. Paternalism becomes undesirable when the entire decision is taken away from the
employee.

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 TOP: AONE competency: Professionalism

3. A patient refuses a simple procedure that you believe is in the patient‘s best interest. What
two ethical principles are in conflict in this situation? a. Fidelity and justice
b. Veracity and fidelity
c. Autonomy and beneficence
d. Paternalism and respect for others
ANS: C
Autonomy refers to the freedom to make a choice (e.g., refuse a procedure), and beneficence
to doing good (performing a procedure that will benefit the patient).

TOP: AONE competency: Professionalism

4. An individual in a wheelchair is applying for the position of receptionist in an outpatient

clinic. What does the nurse manager understand based on The Americans with Disabilities
Act of 1990 requirements for employers?
a. Make reasonable accommodations for persons who are disabled.
b. Allow modified job expectations for persons recovering from alcoholism.
c. Hire disabled individuals before hiring other qualified, nondisabled persons.
d. Treat, for purposes of employment, homosexuals and bisexuals as disabled.
ANS: A
The purposes of the ADA are to eliminate discrimination against persons with disabilities
and to provide consistent, enforceable standards to address discrimination in the workplace.

TOP: AONE competency: Business Skills

5. A staff nurse, who was fired for reporting patient abuse to the appropriate state agency, files a
whistleblower lawsuit against the former employer. What reason would the court provide to
uphold a valid whistleblower suit claiming retaliation by the nurse?
a. Previously reported the complaint, in writing, to hospital administration.
b. Threatened to give full details of the patient abuse to local media sources.
c. Was discharged after three unsuccessful attempts at progressive discipline had failed.
d. Had organized, before filing the complaint, a work stoppage action by fellow
employees.
ANS: A
An employer is unable to fire an employee who, in good faith, reports what is believed to be
a violation of a law, rule, or state or federal law.

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